Sleep Loss Is a Hidden Cost of Caregiving

Their 24/7 role means sleep deprivation for many family caregivers. What can they do to improve sleep?

During 2013, in honor of National Sleep Awareness Week, Caring Right at Home took a look at the latest findings about sleep and aging in the article "Could Poor Sleep Rob You of Your Independence?" Poor sleep quality raises the risk of automobile accidents and workplace injuries, as well as dementia, diabetes, heart disease and an array of other dangerous health conditions. Yet so many of us fail to get enough sleep.

It is notable that the poll that accompanied the article revealed that only one-fourth of Caring Right at Home readers are getting the recommended eight hours of sleep per night. This is not surprising, given that many Caring Right at Home readers are family caregivers! Sleep often drops to the bottom of the priority lists of those who provide care for elderly or disabled loved ones. In fact, according to a study by the National Alliance for Caregiving, 82 percent of family caregivers say their sleep is negatively affected.

Time is one of the main culprits. Family caregivers put in many hours participating in their loved one's healthcare, providing transportation and supervising their loved one's home safety. In addition, many of these caregivers simultaneously hold down a job. Do working caregivers put in fewer hours of care? Many people believe this, but a recent study by the United Hospital Fund and AARP discovered that working caregivers provide almost exactly the same care hours per week as those who are not employed outside the home. It's amazing these busy people can find time for even six hours of sleep!

Time is not the only sleep-robbing challenge for caregivers. Even when they finally turn in for the night, they may toss and turn, plagued by stress and by anxiety about their loved one's health condition and their own ability to provide care. This lack of restorative sleep, in turn, reduces their ability to cope with stress. It can be a cycle of insomnia that is hard to break.

Caregivers' own sleep problems are only part of the picture. When caregivers live in the same household as an ill spouse, parent or other person, their loved one also may have disturbed sleep that affects the caregiver. Caregivers report that they sleep more lightly, vigilant in case their loved one needs help. The International Association for the Study of Pain recently shared a study showing that when one spouse is suffering from chronic pain, the other spouse often finds it difficult to sleep restfully. Study author Dr. Lynn Martire of Penn State University said, "Sleep is a critical health behavior, and individuals whose sleep is affected by their partner's pain are at risk for physical and psychiatric problems." Martire also notes that sleep loss affects the ability to provide good care. She said, "Spouses whose sleep is compromised also may be less able to respond empathetically to patients' symptoms and need for support."

In another ongoing study, this one from the University of South Florida College of Nursing, researchers are investigating the impact that caring for a person with Alzheimer's or other dementia has on the health of family caregivers. People with memory loss often experience sleep disturbances. They may get out of bed and wander the house at night. Many exhibit "sundowning"—restlessness and agitation that worsens as it gets dark, making it hard for them to settle down and go to sleep. This means that bedtime is delayed for the caregiver as well, raising the risk of heart disease.

The American Academy of Sleep Medicine notes that more than half of the nighttime waking of older adults is due to nocturia—the need to urinate during the night. This often wakes up family caregivers as well. They may need to assist their loved one to the bathroom and back; even if their loved one can make these middle-of-the-night trips unassisted, caregivers may be roused to alertness, listening to be sure their loved one is safely back in bed.

What Can Sleepless Caregivers Do?

First, it's important for caregivers to report sleep problems to their healthcare provider. In some cases, exercise, eating a good diet and stress-management techniques can improve sleep quality. If it is not necessary for the caregiver to provide supervision during the night, a "white noise" device can mask sounds of others in the home. The doctor also may prescribe sleep medications.

However, the situation is different if the caregiver is "on call" during the night. Addressing their loved one's sleep disturbances is key. Medication, behavior modification, pain control and lifestyle changes may help. Respite provided by other family members helps some caregivers get a night or two each week of uninterrupted sleep—though "catch-up" sleep can’t take the place of regular, good-quality slumber.

In-Home Care: A Great Sleep Prescription for Caregivers

Many people are unaware that in-home care services can be provided during the overnight hours—so helpful when a senior gets up frequently at night to go to the bathroom, or experiences wandering and sundowning associated with Alzheimer’s disease, or otherwise needs supervision to be safe at night. A trained in-home caregiver can take over the night hours while family get some much-needed sleep, free from interruption or worry.

In-home care promotes good-quality sleep for senior clients in other ways. Seniors who are depressed, lonely and inactive are much more likely to nap during the day and experience restlessness and wakefulness during the night. In-home care encourages mental stimulation, socialization and exercise, which make the client's daytime hours more pleasant so nighttime sleep comes more easily.

In-home caregivers also provide housekeeping and laundry services, freeing family for more relaxing pursuits and perhaps an earlier bedtime. Professional caregivers plan and prepare nutritious meals that meet the client's dietary requirements, including appropriate foods and beverages in the evening hours that won't interfere with sleep.

In-home caregivers take clients to the drugstore or pick up prescriptions, and provide medication reminders. The caregiver can help monitor the effectiveness of sleep medications the doctor may have prescribed. Just as important, caregivers are alert to signs of negative side effects, such as confusion or excess sleepiness during the day.

Even when family live at a distance, worrying about their elderly loved one's well-being can have them tossing and turning at night. Having a professional, trained in-home caregiver on the scene provides reassurance and supervision that equals peace of mind, promoting better sleep for everyone.

Right at Home, Inc. is a national organization dedicated to improving the quality of life for those we serve. We fulfill that mission through a dedicated network of locally owned providers of in home care services.

Poll

Experts predict an increasing family caregiver shortage. What do you think about your own future care needs?

I am confident that family members will be able and glad to help me.

I have family, but I haven’t thought about how much they could help.

I think I’ll be on my own, but I haven’t planned.

I am creating a plan for care that includes professionals.

I am already receiving care.

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